Sun Life Personal Health Insurance: Plan Details

This is not a contract. Actual terms and conditions for the Sun Life personal health insurance plan are detailed in the policy issued upon application approval.

If you have questions please call us at 1-800-474-4474, or email us at inquiries@healthquotes.ca.

Table of Contents

General Information

• Eligibility
• Applying as a couple/family
• Dependants
• Annual and lifetime maximums
• Pregnancy
• Emergency travel medical
• Medical history
• Is a medical required to qualify for insurance?
• When do benefits begin and when are customers eligible to claim?
• How are benefits paid?
• Are premiums tax deductible?
• Are premiums guaranteed?
• How do you receive your policy?

Health Care Plans

• Health Plan Coverage Table

Optional Coverage

• Semi-Private Hospital Room
• Dental

General Information

Eligibility

• Anyone who is 69 years of age or less, is a resident of Canada, and is covered under the provincial health plan in their province of residence. Rates are renewable for age 70+.

Applying as a couple/family

• If you are applying as a couple or family then you must choose the same plan and options for everyone.

Dependants

• Dependants must be under the age of 21 or under the age of 25 if they are in school full-time.

Annual and lifetime maximums

• All annual or lifetime maximums are per person. Annual maximums are based on a calendar year.
• Any unused portion may not be carried forward for use in subsequent years.

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Pregnancy

• If you make your application during your first 20 weeks of pregnancy, you’re eligible to apply for semi-private hospital coverage. The covered length of hospital stay will be limited to 2 days. When the baby is born, simply contact Sun Life Financial within 30 days of the birth and the baby can be added to your plan for a small, additional premium.

Emergency travel medical

• Emergency travel medicalcoverage contains a 9-month pre-existing conditions clause. Your policy provides details about this clause.

Medical history

• Based on the medical history of you or your family, coverage may be declined, modified or given a higher premium.

Is a medical required to qualify for insurance?

• Applicants are asked a number of health questions on the application form. The need for additional medical evidence will depend on these answers.

When do benefits begin and when are customers eligible to claim?

• Benefits begin: once approved; once any waiting periods have been satisfied; when coverage is established. Coverage effective date is not limited to the first day of the month with Sun Life.

How are benefits paid?

• With Sun Life’s pay direct drug card, the portion covered by the plan is paid automatically when the card is presented to the pharmacist. The free my Sun Life Mobile app makes it easier for clients with Personal Health Insurance or Health Coverage Choice to submit claims through their smartphone. They can use their smartphone to submit claims and receive their payment within 48 hours, access their drug or travel card and more. If clients don’t have a smartphone, they can access their Personal Health Insurance or Health Coverage Choice plan on www.mySunLife.ca and receive the same fast and convenient service. Specific information about my Sun Life Mobile app is available on sunlife.ca/mobile.
• Pay direct drug cards are not available for Quebec residents under the age of 65.
• All claims can be filled easily using Sun Life Financial claim forms.

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Are premiums tax deductible?

• Yes, Sun Life’s Personal Health Insurance offers both coverage and the possibility of saving valuable tax dollars.
• To confirm eligibility you should contact your tax advisor or accountant.

Are premiums guaranteed?

• Yes, premiums are guaranteed for one year from the policy’s effective date.

How do you receive your policy?

• Sun Life will mail you a welcome kit directly. This kit includes your policy, pay direct drug card and other valuable information.

Health Care Plans:

	Basic Plan	Standard Plan	Enhanced Plan
General Description	Most economical plan for basic coverage.	Coverage for the same health expenses as Basic but at higher levels. Also with vision and emergency travel medical coverage.	The broadest and most generous level of coverage, including orthodontic and restorative dental coverage.
Prescription drugs	Pay direct drug card (except Quebec) 60% reimbursement No deductible $5 dispensing fee cap $750 max/yr Includes smoking cessation drugs ($250 lifetime max) Excludes fertility drug and contraceptives	Pay direct drug card (except Quebec) 70% reimbursement on the first $7,000 of eligible expenses, 100% on the next $93,000 No deductible $100,000 max/yr Includes smoking cessation drugs ($250 lifetime max) Excludes fertility drug and contraceptives Coverage of reasonable and customary dispensing fees up to the plan reimbursement	Pay direct drug card (except Quebec) 80% reimbursement on the first $5,000 of eligible expenses, 100% on the next $95,000 No deductible $100,000 max/yr Includes smoking cessation drugs ($250 lifetime max) Includes oral contraceptives Excludes fertility drugs Coverage of reasonable and customary dispensing fees up to the plan reimbursement
Preventative dental	three-month waiting period 60% reimbursement $500/yr max.	OPTIONAL three-month waiting period 70% reimbursement $750/yr max.	OPTIONAL three-month waiting period 80% reimbursement $750/yr max.
Restorative dental	Not available	Not available	OPTIONAL One year waiting period 50% reimbursement $500/year max. Includes endodontics, periodontics, oral surgery, crowns, onlays, bridges, dentures (and repairs)
Orthodontics	Not available	Not available	OPTIONAL two-year waiting period 60% reimbursement $1,500/lifetime max.
Supplemental health care	60% reimbursement No deductible Alternative treatments: $25 maximum per visit $250/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000 per fracture or injury Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing: $2,500/yr max. $20,000 lifetime max combined with medical equipment and services	100% reimbursement No deductible Alternative treatments: $300/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000 per fracture or injury Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing: $5,000/yr max. $25,000 lifetime max combined with medical equipment and services	100% reimbursement No deductible Alternative treatments: $400/yr per practitioner Hearing aids $400/5 yrs Accidental dental $2000 per fracture or injury Licensed ground ambulance Emergency air ambulance Medical equipment and in-home nursing: $10,000/yr max. $30,000 lifetime max combined with medical equipment and services
Vision – Prescription eyeglasses, contact lenses, prescription sunglasses, and laser eye surgery.	No coverage	100% reimbursement 1-year waiting period $150 maximum every two years Eye exams up to $50 included in benefit max.	100% reimbursement 1-year waiting period $200 maximum every two years Eye exams up to $50 included in benefit max.
Emergency travel	No coverage	100% reimbursement 1st 60 days of trip $1 million lifetime max. Nine month pre-existing condition clause Out of Country / Out of Province coverage	100% reimbursement 1st 60 days of trip $1 million lifetime max. Nine month pre-existing condition clause Out of Country / Out of Province coverage
Optional benefits Semi-private hospital room	85% reimbursement $180/daily and $5,000 annually Convalescent Hospital: $20 per day up to 180 days per incident	85% reimbursement $180/daily and $5,000 annually Convalescent Hospital: $20 per day up to 180 days per incident	85% reimbursement $180/daily and $5,000 annually Convalescent Hospital: $20 per day up to 180 days per incident
Other services?	Best Doctor’s services	Best Doctor’s services	Best Doctor’s services

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Semi-Private Hospital

• Is an optional benefit on the basic, standard or enhanced plans.
• 85% reimbursement.
• Up to $180 daily and $5,000 annually.
• Convalescent Hospital: $20 per day up to 180 days per incident.

Dental

• Dental coverage is optional for Standard and Enhanced plans.
• The plan includes:
• Exams, diagnosis, tests, x-rays, lab exams.
• Space maintainers for children under 12 years of age.
• Pit and fissures sealant for children under 19 years of age.
• White fillings.
• Scalings, minor extractions.
• Nine month recall visits.
• NOTE: Restorative and orthodontic is included when optional dental is added to the Enhanced plan.

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